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The MILITARY SURGEON. 


CARLISLE, PENNSYLVANIA, 
THE ASSOCIATION OF MILITARY SURGEONS 
1907. 


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o ‘ What zs the Most Effective Organiza- 
tion of the American National Red 
Cross for War and What Should be 
Its Relations with ‘the Medtoal, De- 
partments of the Army and Navy? 


The Enno Sander Prize Essay. 


By MAJOR CHARLES LYNCH, 


MEDICAL DEPARTMENT AND GENERAL STAFF. 
UNITED STATES ARMY. 


Reprint from 


Ihe MILITARY SURGEON. 


CARLISLE, PENNSYLVANIA, 
THE ASSOCIATION OF MILITARY SURGEONS 
1907. 


ene YOR ALUG Ie ee 
SEVOMIS TAO YDIER EVID 
AMACHY 


Che LBnno Sander Prize Essay. 


WHAT IS THE MOST EFFECTIVE ORGANIZATION 
OF THE AMERICAN NATIONAL RED CROSS FOR 
WAR AND WHAT SHOULD BE ITS RELATIONS 
WITH THE MEDICAL DEPARTMENTS OF 
THE ARMY AND NAVY? 


\ By MAJOR CHARLES LYNCH, 
‘, MEDICAL DEPARTMENT AND GENERAL STAFF, 
UNITED STATES ARMY. 


Feist has shown that any military voluntary aid 


association which lacks definite internal organization or 
whose general arrangements for co-operation with the gov- 
ernment are not fixed until the outbreak of war is not in a posi- 
tion to accomplish the best results. Much valuable time will in- 
evitably be lost under such circumstances, for there will be ex- 
treme difficulty in perfecting the details of organization of the 
society and the hurry and stress of war will render almost im- 
possible the establishment of satisfactory relations with the de- 
partments charged with the care of sick and wounded soldiers 
and sailors by law,—the Medical Departments of the Army and 
Navy. So perfected is the organization, in Japan for example, 
where the Red Cross has most proved its worth in a great war. 
that its governing council might have said before the conflict 
with Russia, as did Von Moltke in respect to the German army 
at the beginning of the Franco-Prussian War, ‘“My work is now 
over.’’ Inorder to answer the question at issue, it is, therefore, 
necessary to discuss the American National Red Cross in time of 
peace, as well as in time of war. 
It is possible that all the readers of this paper are thoroughly 
familiar with the present status of this association, but even if 


this be so it is believed that at the risk of a little loss of time it 
(3) 


4 MAJOR CHARLES LYNCH. 


will be best to point out certain of its important characteristics. 
Our present Red-Cross, which has almost nothing in common 
with a former organization of the same name, is young; the Act 
of Congress re-incorporating it (the old society was incorpo- 
rated) was approved as late as January 5, 1905. ‘The list of in- 
corporators contained the names of men and women of national 
prominence. By the act of incorporation the American Red 
Cross is designated as the organization which is authorized to act ~ 
in matters of relief under the Treaty of Geneva. Provision is 
made for a Central Committee, the governing body, which is 
empowered. to organize state and territorial associations, the 
branch societies. The Act states that as soon as there are six 
branches the Central Committee will consist of six persons ap- 
pointed by the incorporators, six by the representatives of branch 
societies, and six by the President of the United States, one of 
whom shall be designated by him as chairman, the others coming 
from the Departments of State, War, Navy, Treasury, and Jus- 
tice.. The Act provides further that the funds of the associa- 
tion shall be audited by the War Department. 

Shortly after the act of incorporation was passed the board 
of incorporators held its first meeting and elected as its president, 
the Secretary of War, who still fills this position. The Central 
Committee elected a distinguishedand energetic executive commit- 
tee A beginning was soon made in organizing branch societies, the 
committee endeavoring in all cases to secure as organizers repre- 
sentative men and women of the various states and territories, 
who could be counted on to interest themselves in the work of 
organization. A board of consultation, composed of the Sur- 
geons General of the Army, the Navy and the Marine Hospital 
Service, was created at the first annual meeting of the Red Cross. 

Interest in the association has not flagged, nearly all the 
distinguished names found on the roll of its Central Committee“) 
at the beginning are still there and the branch societies which | 
are now over thirty in number instead of eighteen as at the first 
annual meeting have enlisted the aid of many prominent people 
in their own localities. At the first annual meeting 3,337 mem- 
bers were reported; in: December, 1906, these had increased to 


THE AMERICAN NATIONAL RED CROSS TN WAR. 5 


over 9,000, when there were 133 doctors and 121 nurses regis- 
tered at the branch societies. At the latter date a balance of 
$7,773.50 was in the Endowment Fund, the general fund of the 
Central Committee. The executive committee has lately passed 
resolutions which will result in the transfer of interest and bal- 
ances of special relief funds to the General Emergency Fund, 
which should eventuate in making available considerable sums 
forthe society. ‘The expenses of administration have always been 
maintained at a low figure, largely because a number of enthusi- 
astic members have worked wholly without pay. An active 
propaganda by means of lectures and a quarterly bulletin, has 
been conducted. The April number of this bulletin announced 
that the District of Columbia branch was preparing to give its 
enrolled nurses a special course of lectures with practical admin- 
istration of field hospital work under the auspices of the medical 
department of the army. So far as known this constitutes the 
first accomplishment in this line, though other attempts have 
been made with much the same end in view. ‘The re-organized 
Red Cross has had no experience in war as yet, but has contrib- 
uted funds for a number of disasters, the greatest of which was 
the San Francisco earthquake. This certainly proved a severe 
test for the methods of the Red Cross in this class of work, and 
the society gained great credit. 

From what has been said it will be noted that the general 
organization of the American Red Cross corresponds very closely 
to that of the same association in other nations, in which organ- 
ized voluntary aid has been the subject of serious study. It was 
manifestly advantageous that the incorporators should be repre- 
sentative people and it has been very wise to follow the policy of 
obtaining this class of men and women for the executive posi- 
tions, both on the Central Committee and-at the branches. Not 
only willthey be most influential in obtaining a large member- 
ship, but their recognized probity insures confidence in the Red 
Cross. The provision in the act of incorporation for audit of the 
accounts of the association by the War Department was also a 
good move in the latter direction. There is one danger in this, 
however, though it may be a remote one. In war, especially in 


6 MAJOR CHARLES LYNCH. 


field work, persons without special training cannot be expected 
to conform in all respects to the methods of accountability of the 
War Department, and to require them to do so could only result 
in unnecessarily hampering them in making expenditures. Timid 
souls would probably spend nothing except a perfect voucher 

were obtainable ‘and sick and wounded might suffer in conse- 
- quence. Quite possibly the Auditor and the Red Cross have 
reached an understanding on this subject. If not it should be 
settled in time of peace as long as vouchers show, so far as they 
can, that expenditures have been honestly made, that the form 
is not of importance and in certain specified cases certified or at- 
tested lists of disbursements should be accepted in lieu of vouch- 
ers. The Red Cross in all countries is given a legal status. 
This, and the fact that by the act of incorporation the American 
Red Cross is authorized to act in matters of relief under the 
Treaty of Geneva will not, perhaps, result, in the event of war, 
in preventing the organization of other aid societies with similar 
objects. Still it will undoubtedly limit their number and the 
evil due to the multiplying of voluntary aid organizations with con- — 
sequent confusion, overlapping of effort, and the frittering away 
of popular resources will be reduced to the minimum. 

It will, be noticed that the composition of the Central Com- 
mittee insures close affiliation with the central government. This 
has proven to be highly desirable in every country, as by this 
means community of effort is better assured. In most countries, 
however, in which it is generally recognized that the Red Cross 
is best prepared to do effective work in war while the aid associ- 
ations are under their own private management as the Red Cross \_ 
is with us when they come into association with the army and 
navy, it is specifically provided by law or regulations that they 
shall be entirely subservient to the governmental services. This 
is accomplished in various ways. In Germany an Imperial Com- 
missioner regulates matters; in Japan representatives of the army 
and navy have places on the central committee and are empow- 
ered to speak authoritatively for their departments. It is not so 
sure, however, that our organization is not, at least quite as good 
a one for us. The Surgeons General of the Army and Navy 


} 


THE AMERICAN NATIONAL RED CROSS TN WAR. vi 


being on the board of consultation should be able to state their 
needs to the Red Cross and what perhaps is just as important, to 
keep informed of what aid that association may be depended 
upon to furnish in the event of war. Moreover, as is the case at 
present, it is probable that both the medical departments of the 
army and the navy will always have represeritatives on the Cen- 
tral Committee. The nature of our institutions would probably 
be opposed to such subserviency as is enforced in other nations, 
and it is thought that with us the same results will be accom- 
plished by relying on the good faith and good sense of our Red 
Cross association. At least it may be safely taken for granted 
that the desire of our Red Cross as now constituted and ad- 
ministered is by all means in its power to strengthen govern- 
mental efforts and not to work at cross purposes with them. 
Neither is it conceivable that a body constituted like its Central 
Committee will ever sacrifice the interests of sick and wounded 
soldiers and sailors by friction with the departments charged by 
law with their care. 


Unfortunately, however, though a step toward it, the mere 
establishment of a community of purpose between the army and 
the navy and the Red Cross does not insure that sick and wounded 
in war will have the attention to which they are justly entitled 
and which both the war and the navy departments and the aid 
association desire to give them. No voluntary aid society has 
ever provided for ill and injured soldiers and sailors in war ina 
satisfactory manner unless the government has also done its 
part. This was illustrated in a striking manner in the recent 
great war in the far East. It may safely be assumed that the 
Russian Red Cross was equally solicitous with the Japanese in 
respect to the succor of sick and wounded soldiers. The former 
had little to build on in the way of an army medical department 
and the latter had a great deal. The result was, especially at 
first, that there was much unwarranted suffering among the 
patients of the Russian army, while with the Japanese, from the 
beginning to the end of the war, sick and wounded had every 
care that conditions permitted. While this may rightly be 
ascribed in part to the better organization of the Red Cross on 


8 MAJOR CHARLES LYNCH. 


the Japanese side, it was primarily due to that country having a 
trained medical officer personnel adequate in numbers to serve as 
a framework on which to build up an efficient organization 
composed of both army and Red Cross. 

This, it is true, is not a matter of Red Cross but of army 
organization and yet to fulfill its high altruistic mission the 
American National Red Cross must take cognizance of the fact 
that with the present wholly inadequate complement of medical 
officers in our army no effort, however great, will give our 
soldiers satisfactory aid in war. Its duty, therefore, seems 
obvious, not only should the association as an association, but 
also its members as individuals, wield what power they have to 
obtain a personnel of medical officers of the army commensurate 
in numbers with what all experience has shown to be required 
if sick and wounded are to escape unnecessary suffering in war. 
The American Red Cross cannot take refuge, like the Chinaman, 
by declaring that this is not its ‘‘pigeon.”’ Nothing could be more 
futile than to go on year after year with an army organization 
which makes failure certain inthe event of war no matter how stren- 
uous may be the efforts of both army and Red Cross at that time. 


The accomplishments of the Red Cross society in war will 
also be largely dependent on the number of its branches and the 
size of its membership. ‘Though, in our association, these are 
still few and small as compared with many nations, a gratifying 
increase in both is shown since the reorganization of the Red 
Cross. ‘There should be no pause in this good work. Branches 
even if they have few members should be organized in every 
state and territory; they must gradually attract members and if 
war comes will, without doubt, serve as nuclei for great mem- 
berships. Naturally the funds seem very small as compared 
with the hundreds of thousands of dollars which some countries 
have collected for sick and wounded soldiers and sailors in the 
event of war, and they are small, too small, from every point of 
view. Rapid augmentation cannot be anticipated perhaps, but 
if the Red Cross is to perform its proper functions much more 
money is necessary. This must come largely from an increase 
in membership. See saan 


THE AMERICAN NATIONAL RED CROSS IN WAR. g 


Little has been accomplished in the creation of a working 
personnel so that to detail methods for its instruction is hardly 
of practical value at present. Just as Soon, however, as any one 

of the branch societies has succeeded in inducing working mem- 

bers to join it, and they should, if possible, include not only 
physicians and nurses, but also the other classes of personnel 
which will be required in war, opportunities should be given to 
show them that they have a part to play in Red Cross work. 
Otherwise their interest cannot be maintained and in consequence 
they will gradually drift away from the association. ‘he plan 
for practical instruction instituted by the District of Columbia 
branch seems/an excellent one. Asin other countries, maneuvers 
should be employed to show the working personnel of the Red 
Cross what their duties will be in war. One practical demon- 
stration of a rest station and a transport column would teach 
them better than pages of written explanation. 

As already stated, so far the work of the American Red 
Cross has been entirely devoted to relief of suffering in disasters, 
and not in war. This is not subject to criticism, on the other 
hand in the absence of war the energies of Red Cross societies 
are quite properly expended in helping in disasters. This is 
recognized by all nations, but it must never be forgotten that 
the primary object of Red Cross associations is the relief of 
sick and wounded soldiers and sailors in war. In some nations 
the Central Committees state frankly that disasters serve only 
as a means of propaganda by enlisting the interest of the 
people and for training the Red Cross working personnel for 
war. We, as we should, intend to go further than this. It is 
certainly a much higher ambition to be equally well prepared to 
relieve the victims of national disasters and of war than those of 
war alone. The latter object must never be sacrificed to the 
former, however. War seems a remote possibility to our people, 
but this should not enter the mind of the Red Cross, which will 
prove of little value for war unless it is so organized and ad- 
ministered that it may play its part therein. 

The general factors which enter into the organization of the 
Red Cross and its relations with the army and the navy have 


# 


10 MAJOR CHARLES LYNCH. 


now been discussed briefly. Before going into details it will be 
well to pause for a moment to consider whether in the light of 
our experience in former wars there is not something further 
which the American Red Cross could do to ameliorate conditions 
in the army and the navy in war. The question immediately 
arises, in the past what has been the cause of the greatest 
amount of preventable suffering in our forces? The answer is 
reached without hesitation—bad hygiene. As has previously 
been pointed out by Colonel John Van R. Hoff, assistant surgeon 
general, United States Army, universal instruction of our people 
in the laws governing sanitation would seem to be a peculiarly 
appropriate field for Red Cross work. ‘The day will undoubtedly 
come when the rules of personal hygiene will be scientifically 
taught in our schools, but it might be much advanced by the 
Red Cross Association. The basis of such a plan might well be 
to interest the branch societies in the scheme and through them 
to induce states and municipalities to adopt a uniform and proper 
method of instruction. "The matter of each citizen of the re- 
public being informed on the means for preserving his health is 
certainly of national importance. So true is this that it would 
seem as though the National Red Cross might take a part in the 
work and with the assistance of a few qualified sanitarians pre- 
pare a simple text book which could be distributed through the 
branch societies. This scheme might be much expanded— many 
a locality has peculiar health conditions. ‘These might be treated 
in pamphlets with directions how best to avoid the prevalent 
diseases and on the occurrence of an epidemic a branch society 
might circulate leaflets telling of the special methods of preven- 
tion of infection. It is believed that more lives of citizens would 
be saved by these methods than are sacrificed to either wars or 
disasters and not only this but soldiers and sailors entering the 
service would have some idea of caring for their health, would 
be taught military sanitation with more facility, and in con- 
sequence our armies would not be a prey to disease as they 
always have been in the past. It is realized that such a work 
would take money, but after all vast sums would not be required 
for it and there should be no great difficulty in obtaining them 


THE AMERICAN NATIONAL RED CROSS TN WAR. EE 


as the time is now ripe for general instruction in preservation of 
health as well as in the subjects which are considered to consti- 
tute an ordinary education. Persistent effort would be required, 
perhaps for a number of years, and there would probably be no 
lack of temporary discouragements, but as a recompense ultimate 
good results would be practically certain. 

So far in this discussion, except for the remarks just made 
on the subject of hygiene, only the organization and relations of 
the American Red Cross with the army and the navy as they ex- 
ist today have been taken into account. From what has been 
said it will be realized that an auspicious beginning has been 
made and that so far as general arrangements are concerned there 
is really little room for improvement. It may then be conceded 
without further question that we have at last secured a Red 
Cross that is still woefully lacking in members and in money but 
which aside from this fact, and it will be remedied in time, has 
an organization capable of accomplishing the best results if only 
the details of its operations are properly determined and fixed. 
In war every voluntary aid association must furnish either mate- 
rial or personnel or both. It will, therefore, be well to study, 
first what material and personnel our own people have supplied 
voluntarily in past wars and what are generally furnished, with 
special reference to our needs, and then to consider the organiza- 
tion best fitted for the distribution of material and how the ser- 
vices of Red Cross personnel can best be utilized by the army 
and the navy. For obvious reasons, in this discussion it is not con- 
sidered necessary to investigate matters which are without prac- 
tical value for us at the present time. 

A great part of the work of the Christian and Sanitary Com- 
missions in the Civil War, though by no means all of it, consisted 
of collecting and distributing the class of material which immedi- 
ately suggests itself tothe popular mind as that which is required 
for sick and wounded soldiers and sailors, and in the collection of 
money for the purchase and distribution of such material. ‘This 
consisted in the main of medicines, surgical dressings, clothing, 
blankets, foods, especially though not always delicacies, liquors, 
wines and books, periodicals and newspapers. With certain 


12 MAJOR CHARLES LYNCH. 


modifications, which readily suggest themselves, their lists of ar- 
ticles supplied, might be used for this class of material in any fu- 
ture hostilities. The Spanish-American War certainly did not 
show as good a knowledge on the part of our volunteer aid so- 
cieties of the needs of ill and injured soldiers in this particular. 
If supplying such needs were the only end and object of our 
present Red Cross still its work would be justified. Itis the right 
and privilege of the people to provide for their soldiers and sailors 
and the patriotic impulse to do so could be met in this way with the 
certainty that all money and gifts would reach their destination. 
Still it is obvious that gifts of the character mentioned may be 
supplied by the War and Navy Departments as easily as by the 
people, nor is it probable that money will not be available for this 
purpose in any war we may have in the future. The worth of 
such gifts is, therefore, rather in the field which they offer for 
the display of patriotic sentiment, and for kindling it—those who 
cannot bear arms should have a part in upholding their country’s 
cause—than in their actual value, though naturally they have 
value, saving money in taxation and thus a portion of the bur- 
den is put on the willing shoulders of those who presumably can 
best afford to bear it. 

Desirable as this form of contribution is from some stand- 
points it does not compare in practical importance with another 
form of voluntary aid in material. No nation, however rich, 
attempts to provide in peace all the material it will require for 
sick and wounded in war, yet on the outbreak of war certain 
things will be urgently required which the government cannot 
supply on a moment’s notice. The modern tendency, since the 
Franco-Prussian War, in many countries is to rely at least partly 
on the Red Cross to meet demands of this character. This ne- 
cessitates a permanent Red Cross organization and very consid- 
erable funds. Material of this class has mainly to do with the 
transportion of sick and wounded and to a less extent with their 
shelter. 

The furnishing of hospital ships for the army and the navy 
seems a particularly appropriate field for Red Cross work as gov- 
ernments do not usually maintain such ships in time of peace 


THE AMERICAN NATIONAL RED CROSSINWAR, - 13 


except perhaps one or two for navy use. On the outbreak of 
war the demand for them is likely to be urgent and even if pas- 
senger steamers can be obtained much valuable time must be lost 
in converting them for hospital purposes. With the United States, 
of all great nations, the lack of hospital ships is likely to be most 
severely felt as on account of our small merchant-marine, few 
suitable vessels are available for conversion and it is probable 
that any campaign we may have will be overseas. It is realized 
that sufficient funds are not likely to be available to our Red 
Cross for this purpose for many years but when they are it is 
doubtful if they could be better invested’ than in the purchase or 
preferably the construction of a vessel or vessels which can be 
used both for the passenger service and for hospital ships. Japan, 
poor as she is, has had two such ships for a number of years, 
though with her enormous subsidized fleet they are not nearly as 
necessary as with us, in fact they constituted but two out of 
eighteen of such ships that Japan used in the Russo-Japanese 
War. ‘The Japanese hospital ships are in service by a steamship 
company in time of peace with an agreement that on the out- 
break of war they will be promptly delivered to the Red Cross 
which itself stores their hospital fittings when they are not needed. 
A much cheaper plan, though not equally satisfactory, would be 
for our Red Cross to enter into a contract with a steamship com- 
pany that a certain vessel or vessels shall be turned over to the 
association on the outbreak of war. Plans can be made for 
adapting such vessels for hospital purposes and the necessary fit- 
tings which would cost comparatively little can be purchased and 
stored. Vessels for the river transport of sick and wounded are 
not so essential to our needs, and more river steamers than sea- 
going vessels are available, so plans for the former may safely 
await the advent of war. -. 

We should be foremost in poco trains as the vast extent 
of our country will demand much train transportation of ill and 
injured in time of war. The ordinary Pullman sleeping car pro- 
vides an excellent ward but we have nothing in the way of an 
operating car at present and this is also a good field for Red 
Cross activity. Preferably such cars should be bought so as to 


14 MAJOR CHARLES LYNCH. 


be ready for immediate use, but if this is impracticable at least 
careful plans should be secured so that on the outbreak of war 
commercial coaches can be promptly remodeled for this special 
purpose. Sleeping cars will not always be available for all ill 
and injured and appliances to fit box cars and coaches to carry 
patients in a recumbent position will be required in numerous 
instances. Such appliances are very commonly purchased and 
stored by Red Cross societies. 

One of the lessons which the Spanish-American War taught 
was the necessity of separating the sick from the well in order to 
diminish the danger of contact infection. It is hoped that in 
any future war this will result in the army establishing good 
semi-permanent, not tent, hospitals on healthy sites at a distance 
from the camps of mobilization. This is perfectly practicable if 
means of transportation are available, but not otherwise. Could 
not the Red Cross make plans to adapt the ordinary automobile 
(touring car) for the transportation of sick and wounded at such 
camps? Ambulances, both automobile and horse-drawn are 
always required in such great numbers in war that it is almost 
impossible for governmental agencies to meet the demand for 
them and they therefore offer still another field for the expendi- 
ture of Red Cross funds. Some countries, notably Austria, sup- 
ply wagons as well as ambulances through the Red Cross; this, 
of course, is simply to make up complete organizations imme- 
diately available for field service but it seems that as there are 
so much more important demands on Red Cross funds the pur- 
chase of wagons should await the outbreak of war. 

European nations are generally agreed that their Red Cross 
societies will find an important part of their work in the estab- 
ment of rest stations or infirmaries at railway stations. Supplies 
for these are quite commonly gotten together in time of peace 
but they are so comparatively easily secured when war comes 
that with us they need not be considered at present. 

Permanent hospitals to be devoted to the use of the army 
and the navy in war will hardly receive attention from our Red 
Cross for years to come, if they ever do. Conditions are quite 
different with us and the Japanese. In their country something 


THE AMERICAN NATIONAL RED CROSS IN WAR. 15 


has been done in this line, for there it is necessary for the Red 
Cross to provide hospitals to train some of its persounel so they 
are ready for use on the outbreak of war, while with us there is 
no necessity for the association to occupy itself in teaching its 
nurses and, therefore, for hospitals to do so. Portable hospitals 
for the lines of communication are on a different footing from 
permanent hospitals and may quite properly be supplied by the 
Red Cross. The British in the South African war had a num- 
ber of such hospitals some of which bore the names of their 
donors. Field hospitals were also supplied by the British volun- 
tarily in that war, though rather by the munificence of a few 
rich men than through the efforts of their voluntary aid societies. 
Obviously it might be possible in war for our Red Cross to ob- 
tain such hospitals from some of our wealthy citizens. This 
would be a subject for thought in the event of war, but it would 
hardly be best to try to secure such hospitals in time of peace as 
the army itself has a number of them and the Red Cross can oc- 
cupy itself in other more useful directions. 

Hospital ships, trains, wagons, ambulances, hospitals, etc., 
supplied by it, of course, pertain permanently to the Red Cross 
and if they are temporarily in use by the army, revert to the as- 
sociation as soon as they are no longer required. AIl nations, 
however, rule that the class of material which was mentioned 
first: medicines, clothing, blankets, food, etc., etc., once turned 
over to the army or the navy becomes the property of the govern- 
ment, nor is any other plan possible except at the risk of absurd 
claims from irresponsible people. 

The working personnel which the Red Cross may be called 
upon to supply in time of war will consist mainly of physicians, 
possibly pharmacists, both men and women nurses, bearers, 
cooks, drivers and laborers. In addition a number of men of 
business experience will be required for positions connected with 
administration, the collection and distribution of supplies, and 
like duties. Women nurses, generally, in both the empires of 
Russia and Japan; are largely educated under Red Cross auspices. 
In both countries this is necessary as otherwise not enough 
trained women nurses could be procured for the needs of the 


16 MAJOR CHARLES LYNCH. 


army and navyin war. Fortunately there is no necessity for us 
to educate women as nurses as the various hospitals and training 
schools throughout the country furnish’so many that an adequate 
supply would always be available for any war. To us, there- 
fore, the more simple alternative is presented of merely enrolling 
women nurses who have already received their professional train- 
ing and the same is true of physicians and pharmacists, if the 
latter are to be employed. No place is given them in the organ- 
izations which will be discussed in this paper. ‘The supply of 
men nurses, of whom many are likely to be needed, offers a much 
more serious problem and one to which no very satisfactory 
solution can be given. Obviously our Red Cross cannot main- 
tain hospitals for training such nurses, and the country generally 
affords no great number. Probably the best plan in practice 
will be to employ women as nurses wherever they can be used 
and to assign all men procurable who have had any experience 
in nursing to that particular duty. Considerable difficulties are 
apparently experienced in all countries in securing a competent 
force of Red Cross bearers. If such men could be enrolled by 
the branch societies in time of peace and then given simple in- 
struction in first aid and bearer duties, preferably as companies, 
this would be the most satisfactory plan. It is, it will be re- 
membered, practically the method followed in Great Britain. 
Even on the advent of war, by organizing such companies, a 
great deal can be accomplished, and it would probably not be 
difficult to obtain men at this time. ‘The business men required 
for administrative positions can hardly be given special training 
in peace. There will be great advantage, however, in enrolling 
as large a personnel of all classes as possible in time of peace so 
that the Red Cross may have something to depend upon if war 
comes; moreover, naturally all men and women enrolled will 
take some interest in Red Cross matters so they will be better 
prepared to perform the duties which fall to them in war than 
persons who have previously given no attention to voluntary aid 
work. | 

In the case of all Red Cross personnel in peace or war good 
health as proved on examination, good character and sufficient 


os 


THE AMERICAN NATIONAL RED CROSS IN WAR. L 


education to fill the position for which selected, are prerequisites 
for enrollment. The act of enrollment should be as formal as 
possible in order that the working members may realize that they 
have actual obligations; persons not willing to accept such obli- 
gations are not wanted by the society. It is very necessary that 
the Central Committee of the Red Cross should know at all times 
how large a percentage of the enrolled working personnel can be 
turned out in the event of war and even more necessary perhaps 
for the medical departments of the army and the navy to be in- 
formed on this subject, as without it they cannot place much de- 
pendence on the Red Cross so far as personnel is concerned. In 
many countries a close check is kept of this by means of maneu- 
vers to which the Red Cross is called out at frequent intervals. 


In the event of war, all Red Cross personnel actually em- 
ployed with the army or the navy should be supplied with cer- 
tificates of identification and with arm badges of neutrality, 
which should bear the same number as the certificates. These 
may be furnished by the society but all certificates should be 
countersigned by the military authorities before they are held to 
be valid. This had best be done by a medical officer, 


There is no question but that the working personnel of the , 
Red Cross, when employed in the army or the navy should be 
under army or navy discipline and command as the case may be. 
This should be settled at the outset and none should be accepted 
except with this understanding. To do otherwise would be to 
put the Red Cross outside of the law and regulations much as 
would be the case in a civil community if certain persons were 
exempted from the operations of law and so were not held respon- 
sible for their actions. Infractions of law or discipline on the 
part of individuals of the Red Cross should ordinarily be pun- 
ished by summary discharge by the senior medical officer, with 
report to the immediate commander and to the Surgeon General, 
but for more serious offences the same officer should prefer charges 
in the proper form. Special orders will, of course, be required 
for Red Cross personnel as well as for officers and soldiers and 
their actions must be equally governed by such orders. All 
should be required to make personal reports to the senior 


18 MAJOR CHARLES LYNCH. 


medical officer of the command to which they are attached. 
The usual practice and it is avery good one, is to employ the 
personnel of the Red Cross solely at home, on hospital ships and 
on the lines of conimunication; service at the front being confined 
to the medical department. No one would probably suggest put- 
ting Red Cross personnel on a battleship; the front in an army 
corresponds rather closely to the battleship, and to mix Red 
Cross personnel and the personnel of the medical department 
there is likely to result in even more confusion than to do so on 
a ship of war. ‘This was perhaps the weakest point in the or- 
ganization of the Russian Red Cross, which, by scattering re- 
sponsibility between the army and the Red Cross .at the front, 
made neither responsible for the service and a great deal of trouble 
followed. With better administration, difficulties of this nature 
would, of course, have been diminished, but even so there are a 
sufficient number of places where working members of the Red 
Cross can be of the greatest use in time of war without putting 
them at the front where their previous training does not fit them 
to perform the special duties toward which the entire education 
of the medical department should tend. It can, of course, be 
argued that while this may be true of the regular medical de- 
partment it is not so of volunteer medical officers of whom we 
must necessarily have many in war. It may be freely admitted 
that unless there is a strong leaven of trained officers that the re- 
sults are not likely to be satisfactory but further to complicate 
conditions by introducing another factor in the person of the 
Red Cross could only make bad matters worse. A certain amount 
of elasticity should nevertheless be maintained, and in my opin- 
ion it should be provided that habitually members of the Na- 
tional Red Cross Association will be employed under direction 
of the commander and the chief surgeon only on the lines of 
communication, on hospital ships, and at home, but that under 
exceptional conditions when army personnel is not available, 
they may be used at the front where subsequently they will be 
replaced by army medical personnel as soon as conditions permit. 
Preliminary arrangements for the work of the Red Cross should 
naturally be made with these ends in view. Whenever it becomes 


THE AMERICAN NATIONAL RED CROSSIN WAR. 19 


necessary to use the Red Cross personnel at the front, it will be 
found best to attach it to some medical department organization 
and thus to have it under the direct command of a medical officer. 
Red Cross field hospitals will be spoken of later. 

While the value of women as army nurses is now universally 
admitted, their sphere of usefulness is limited whether they be- 
. long to the army or to the Red Cross. Perhaps it would not be 
wise for us to confine the services of women nurses absolutely to 
home territory and to hospital ships by iron rules as do the Jap- 
anese, but it should be understood with us that women will only 
be used under the rarest circumstances on the lines of communica- 
tion and that they will never be employed with the advance. The 
experience gained from Russia in her recent war with Japan was 
that with women in the field medical organizations at the front, 
on account of the danger from the fire of the enemy these were 
likely not to be carried far enough toward the line during battle 
to be effective. This is not an imputation on the courage of the 
women nurses of the Russian army for this would be unjust as 
many of them exposed themselves fearlessly; it shows rather the 
effect that the presence of women had upon the minds of the 
commanders. 


With us, as it is not contemplated that the Red Cross will be 
put to the expense of educating its working personnel, it isthought 
that the association should provide uniforms, pay and rations for 
it while it is in the service of the government. If funds are 
available there will be no difficulties in reference to the two for- 
mer, but while it will be better for the Red Cross always to pro- 
vide its own rations when practicable and thus not to burden the 
supply department, charged with the duty of furnishing the army 
with food, with its needs, circumstances may not infrequently 
be such in the field that rations can only be obtained from an 
army commissary. ‘Therefore, it should be provided that when 
necessary, on recommendation of the chief surgeon, with the au- 
thority of the commander, Red Cross personnel may be issued 
the army ration and be allowed to supplement it by purchases 
from sales stores. 

The rate of pay is in a measure a matter which concerns the 


20 MAJOR CHARLES LYNCH. 


internal administration of the Red Cross yet it affects the army 
medical department too, for different rates of pay for the perform- 
ance of similar duties in association and army will be a prolific 
cause of dissatisfaction. Therefore, it is believed that the wage 
scale, with allowances, of army and Red Cross should be the 
same. ‘The question of pensions will always arise in connection 
with deaths or disabilities of Red Cross personnel in service. 
Some associations provide for, these from their own funds but so 
far as known no government assumes this obligation. 

In addition to the personnel, which has just been discussed, 
each member of which has certain qualifications which fit himypr 
her to fill a special post in Red Cross work, it must be remem- 
bered that places must be provided for a large class of persons, 
mostly women, who have no professional trade or business quali- 
fications. ‘Their services should not be scorned for this reason, 
however, and they may be made of considerable value if properly 
directed and organized. ‘There should be no attempt to utilize 
them as amateur nurses any more than as amateur physicians or 
in other places for which technical training is required. The 
story of the soldier at Montauk Point in the Spanish-American 
War, who, not feeling strong enough for amateur nursing on a 
certain occasion put up the sign ‘‘too sick to be nursed today,”’ 
and of the officer whose face was washed seventeen times in one day 
by relays of vigorous and zealous amateurs, it must be admitted 
are very funny but they also have their serious side. Certainly 
our soldiers and sailors have the right to be protected from such 
treatment. Ill advised and misdirected efforts are positively very 
dangerous in certain cases, especially in patients suffering from 
typhoid fever, to whom improper food is so often given by un- 
trained attendants. The field for the employment of this class 
of personnel will of course, be practically limited to the home 
territory where it should minister to the comfort but not indulge 
in treatment of sick and wounded. In hospitals such persons 
should be occupied under proper direction in reading to patients, 
writing letters for them, bringing them flowers and fruit, and 
in certain selected cases giving spiritual consolation. Such ser- 
vices will naturally be purely voluntary and wholly without pay, 


¥ 


4 


THE AMERICAN NATIONAL RED CROSS IN WAR. gut 


nor should those proffering them be subjected to army discipline 
further than that they should be required to respect the orders 
of the senior surgeon on matters having to do with patients. 
The right of this officer to exclude persons who refuse to comply 
with hospital regulations must always be maintained in the in- 
terests of sick and wounded. 

The present almost universal practice, and it-is a good one, 
is for the Central Committee to exercise a general supervision 
over the branch societies in regard to both material, including 
money, and personnel. Money for general objects, much of 
which comes from the branch societies, is expended by the Cen- 
tral Committee; that for local objects is spent locally after 
branch societies have consulted with the Central Committee. 
Popular gifts for general use contributed to the branch societies 
are distributed as directed by the Central Committee. The 
training of the personnel is usually entrusted to the branch 
societies, the Central Committee forming a comprehensive plan 
in which all participate. 

It is anticipated that in any future war the work of our Red 
Cross will be truly national in character, that state and sectional 
feeling will be reduced to the minimum, and that the efforts of 
the voluntary aid society will be expended for the benefit of our 
soldiers and sailors as a whole without regard to the part of the 
country from which they come. ‘his is alluded to as states act- 
ing individually in the field have proved a decided embarrassment 
‘to good administration in many instances in the past. ‘The ex- 
igencies of war make the territorial division of soldiers an artificial 
one; they cannot be aided according to state lines, and any at- 
tempt to do so appears bitterly unjust to one soldier who resents 
more consideration for a comrade simply because he comes from 
a rich, energetic and liberal state. This, of course, does not im- 
ply that branch societies, after consultation with the Central 
Committee, will not be permitted to create their own local or- 
ganizations in the home territory for the aid of all soldiers and 
sailors present who may require it. - 

If the work of the Red Cross is to be national in character, 
the general government and administration of the association 


22 M/JAOR CHARLES LYNCH. 
must center in Washington in the Central Committee which, 
moreover, is best fitted to act for the society on all general prob- 
lems as it is in close relations with the Surgeons General of the 
army and the navy. ‘The number of departments which are 
created in the Central Committee will naturally depend on what 
lines of work are taken in hand by the association. Certainly 
one will be required for material, one for personnel, and one for 
correspondence and to answer general inquiries. Some countries 
depend largely on their Red Cross associations for information in 
response to inquiries of anxious relatives and other personally in- 
terested citizens, on the location of soldiers and sailors, generally, 
and especially of sick and wounded. This would appear to be 
a work on which our Red Cross could properly embark in time 
of war. If it did so a special section would be required, and this 
should be organized by the Central Committee as it would be in 
the best position to obtain the information needed from the gov- 
ernment. ‘The Surgeons General of the army and the navy 
would, of course, be available to advise the Central Committee 
in regard to its war organization, but with the army at least the 
details are so complicated that it would probably be best for the 
Surgeon General to detail a medical officer, thoroughly familiar 
with conditions and with administration to the Central Committee 
so that he would be on hand with his advice and assistance 
whenever it might be required. While a good deal of aid will un- 
doubtedly be offered to the Central Committee directly, the ma- 
jor part must come from the branch societies which should cover 
their entire territory so that no part of it will remain unreached 
in their appeals, whether they be for material or personnel. 

The organization for the supply of material in war is per- 
haps the simplest; at present this is held to include only material 
in the form of popular contributions, including money. As has 
been stated the expenditure of money for general objects is the 
duty of the Central Committee, to which branch societies should 
transmit such proportion of their collections as they have 
mutually agreed upon for devotion to such purposes. ‘The Cen- 
tral Committee will then keep informed of the needs of the army 
and the navy from governmental sources so that the money can 


THE AMERICAN NATIONAL RED CROSS 1N WAR. 23 


be spent on articles which are most needed. This would not, of 
course, prohibit purchases by branch societies under direction of 
the Central Committee when it is advantageous to buy locally, 
or for local objects. The method that will be found most useful 
in the purchase of many articles by the Central Committee will 
probably be to make them through the supply departments of 
the army as was done in the San Francisco earthquake since the 
latter have an organization for buying. Certain sums will have 
to be set aside by the Central Committee for expenditures by 
delegates, etc., and the pay and expenses of the personnel will 
also have to be provided for. The branch societies should estab- 
lish storehouses in their territory at the most convenient points 
and constant communication should be maintained with the 
Central Committee so that stores may be shipped to the proper 
places according to its directions. Delegates appointed by the 
Central Committee, usually on recommendation of the branch 
societies, should be stationed at mobilization camps, at large 
hospitals pertaining to either army or navy and on the lines of 
communication of the army. Each such delegate should be 
given money for the use of sick and wounded and should be the 
agency by which material contributed by the Red Cross reaches 
the il] and injured of the command to which he belongs. Delegates 
should be in close touch with the chief or senior surgeon so that 
they may at all times be informed what they can do for the 
patients in their own commands. This information should be 
conveyed to the Central Committee at appropriate intervals with 
requisitions for supplies. Emergencies always arise in war which 
render it extremely difficult for governmental agencies to de- 
liver supplies to points where they are required. While it would 
be hardly practical -under most circumstances for the Red Cross 
to maintain supply wagous of its own in the field, sometimes 
this may be necessary and often in consultation with the chief 
surgeon and with the authority of the commander, the Red Cross 
delegates by utilizing local resources may succeed in transport- 
ing their supplies to the points designated. 


All European nations attempt to divide their Red Cross per- 
sonnel into organizations which with a certain allowance of ma- 


24 MAJOR CHARLES LYNCH 


terial form distinct and separate units. This is very desirable as 
it makes the Red Cross responsible for certain work without let 
or hindrance except that necessarily imposed by superior au- 
thority. 

The organizations which are almost universally admitted to 
be the best fields for Red Cross work are: 

Rest stations. 

Hospital trains. 

Hospital ships. 

Transport columns on the lines of communication. 

It will be noted that none of these involves much so-called 
paper work, which is naturally the bugbear of a voluntary aid 
association. Moreover there are certain records which in justice 
to both government and soldier must be made by commissioned 
officers of the army or the navy. ‘The choice of these four fields 
of effort for the Red Cross is also perhaps partially dependent on 
military necessities. Naturally the humanitarian side of the 
question is nearer the hearts of the Red Cross than the practical 
one of maintaining fighting efficiency. Therefore, members of 
the association are not put in positions where this can allow them 
to deplete the front. General Banks is reported to have said on 
one occasion in our civil war that the Sanitary Commission had 
stolen his entire army. 

Rest stations should be established on the lines of communi- 
cation and at home, at ports and at railway stations, through 
which the majority of soldiers and sailors are expected to pass. 
At home they may quite properly be organized by branch socie- 
ties with the authority of the Central Committee. A Red Cross 
physician should be appointed as chief of the station. Rest sta- 
tions are preferably divided into two sections according to the 
Japanese plan, a comfort section and a treatment section. The 
comfort section which has no personnel with technical training 
but is made up wholly of patriotic men and women of the locality 
should meet every train or ship to cheer soldiers and sailors on 
their way and to show interest in them on their return from the 
front. Water, perhaps lemonade, and the fruits grown in the 
vicinity, possibly broth or other nourishing food, magazines, the 


wr 


a 


THE AMERICAN NATIONAL REV CROSSTIN WAR. 25 


daily papers, etc., may properly be supplied by this section. The 
treatment section, made up of patriotic doctors and nurses, will 
be expected to give emergency treatment, to readjust dressings 
and the like and perhaps to furnish stimulants or restoratives. 
All this should be done under the direction of a physician. When- 
ever a rest station is established a building had best be taken for 
the shelter of the personnel and material. 

The personnel of stations will naturally vary with their size 
and importance. The local character of the employment will 
usually permit it to be an ample one. Besides the chief, one or 
two physicians should be provided in the treatment section for 
each hour of the day and night when their services are likely to 
be needed as well as about two men and eight women nurses. 
The comfort section should have from fifteen to twenty persons, 
the majority of whom may be women. As workin a rest station 
at home will not take its personnel from their ordinary voca- 
tions, the service should be wholly without pay except for acare- 
taker or two. ‘The material required is naturally suggested by 
the duties to be performed. At home purchases can generally 
be made as articles are needed. Organizations very similar to 
rest stations may also be established in cities where many sol- 
diers are likely to congregate. For these the desirability of or- 
ganizing reading rooms and dormitory facilities should be con- 
sidered. Untrained personnel of the Red Cross who desire to 
do their part by visits to hospitals should preferably be organized 
into comfort sections corresponding to those just described at 
rest stations. Manifestly if a prominent woman of the locality 
can be obtained to head each such organization it will be a de- 
cided advantage. 

Hospital trains may well be manned by the Red Cross. If 
such trains are furnished both by the army and the association 
it will often prove wise to give over the management of at least 
some of the army trains to the Red Cross with one medical officer 
-in charge. The allowance of personnel for hospital trains in the 
lines of communication and at home should bethe same. Inthe 
former, as trains for. patients may very likely consist in part of 
ordinary cars returning from the front which will only make one 


26 MAJOR CHARLES LYNCH. 


trip, it will be necessary to assign Red Cross personnel for them 
as well as to hospital trains. The organization for both hospital 
ships and trains is given in the Manual for the Medical Depart- 
ment of the Army. The Red Cross in the absence of trained 
men nurses will probably be compelled to substitute women for 
them in the hospital ships and the home trains. In the lines of 
communication, as has previously been stated, men should be 
employed in place of women nurses. ‘The organization of parties 
sent to the lines of communication for service on temporary trains 
for patients should be that specified in the medical manual of the 
army for a hospital train. The number of such parties will de- 
pend upon circumstances, and, of course, the line of communi- 
cation chief surgeon will be at liberty to employ halves or other 
subdivisions of the parties as he may see fit. 

Land transportation of patients in the lines of communica- 
tion has always proved a difficult problem in war. In order to 
meet the need in this direction several nations have organized 
transport columms for patients from the Red Cross, though up to 
the present time this association has not participated in this work 
to a very notable extent. The Japanese had but two such col- 
umns in the recent great war and did not apparently consider 
that they offered a particularly good opening for the Red Cross 
as they did not attempt to organize more during the course of 
that conflict. Whether their experience in this respect is of 
value to us is problematical; in fact Japan, it must be admitted, 
is so much more liberal in peace in providing for a sufficient med- 
ical department in war than we are, that her needs are much less 
than ours, when war comes. ‘The most convincing argument 
against organizing transport columns by the Red Cross appears 
to me to be that in this field the training of the army medical 
officer is almost essential to good work. However in a great war 
the services of trained medical officers would probably be more 
essential elsewhere, so of necessity this work might fall on the 
Red Cross. The organization suggested for such a column is one 
Red Cross physician in charge, three assistant physicians, three 
medical students or clerks as assistants, twenty men nurses, 
twenty-three drivers, ten men for general work. The transpor- 


THE AMERICAN NATIONAL RED CROSSTINWAR. 27 


tation should consist of twenty ambulances and three escort 
wagons. The greatest liberality should be permitted in hiring 
bearers and transportation locally. The material should com- 
prise about six chests of medical and surgical supplies, blankets, 
bed sacks, litters, food for patients and personnel, and means for 
preparing it. The duties of such a transport column will be 
identical with those of a train for wounded in the lines of com- 
munication except that the former will operate across coun- 
try, and when the distance which it has to cover is great it may 
be necessary for the personnel to establish rest stations en route 
for the temporary shelter and care of patients over night or for a 
slightly longer period. 

To entrust the duty of furnishing field hospitals to the Red 
Cross rather implies a deficiency in the medical department of 
the army concerned, as the needs of the front in all respects 
should certainly be met by that department without extraneous 
aid. If, however, the magnitude of a war is such that assistance 
in this direction is required from our Red Cross it is suggested 
that the organization and supplies as prescribed in the manual 
for the medical department of the army be followed exactly. 
These have been carefully worked out and represent the best 
ideas on the subject in view of the organization of our army. If 
the Red Cross furnishes field hospitals we cannot do better than 
to pattern after the British by putting medical officers of the 
regular army in command of them. Thusa trained man is made 
responsible for the administration and the Red Cross personnel 
is left free to do its own proper work—actual treatment of sick 
and wounded. 


Reference has already been made to the improbability of the 
Red Cross organizing large hospitals in home territory and it 
would be even more unwise for the association to attempt to do 
so on the lines of communication. There is, however, a certain 
kind of semi-hospital organization in which the Red Cross can 
well be utilized. This is the convalescent camp. In all wars 
there are men who no longer require hospital treatment but who 
are not in fit physical condition for return to their organizations 
and at the termination of a war, many such men will also be 


28 MAJOR CHARLES LYNCH. 


found who are not yet in condition to return to their pursuits in 
civil life. As suggested by Major W. D. McCaw, Surgeon 
United States Army, all this class of men might be furloughed 
and sent to convalescent camps conducted by the Red Cross. 
There are certain other cases which will never be fit for further 
service and that require extensive and long continued medical or 
surgical treatment. These men might also be furloughed and © 
sent to a hospital operated by the Red Cross. This might be 
called ‘‘Red Cross Hospital for Special Treatment.’’ It will be 
the better plan to make both this and the convalescent camp 
auxiliaries to large general hospitals so that the latter may ac- 
count for patients and to which patients on the termination of 
their furloughs can report for final disposition. It would not be 
necessary that either the convalescent camps or the special hos- 
pitals should be at the same place as the hospitals to which they 
are attached and naturally in certain cases it might be better for 
a medical officer from the general hospital to visit the convales- 
cent camps or special hospitals instead of compelling men to report 
tothe former. Aside from such visits the work of both camps and 
special hospitals might be left wholly to the Red Cross, subject, 
of course, to such medical inspections as would be prescribed for 
the whole army. Convalescent camps and special hospitals 
might be organized either by branch societies or by the Central 
Committee. 

As was the case in South Africa, in any war in which we 
may engage provisions will have to be made for invalid officers. 
Many of these will require little treatment but must have rest, 
good food, and favorable surroundings. ‘The plan thought of at 
that time, of having the Red Cross accept offers from proper per- 
sons to receive such officers as their guests would be a boon to 
many who are not quite prepared to give themselves the benefit 
of residence at places which will most quickly promote their cure 
and so prove of value to both themselves and the government 
which they serve. 

While the army has been treated at much greater length 
than the navy, the organization of the former being taken as 
that on which the organization of the Red Cross should be 


THE AMERICAN NATIONAL RED CROSSIN WAR. 29 


modeled, the needs of the navy have been mentioned now and 
again. ‘There is no intention in thus discussing the army to 
imply that the Red Cross cannot also play an important part in 
the work of the naval medical department in war. Naturally 
conditions in the navy vary considetably from those in the army, 
so a few words will now be devoted to the special needs of the 
former. War service in the navy is such that the efforts of the 
Red Cross in conjunction with its medical department will be 
almost entirely confined to home territory. It would hardly be 
possible to utilize the services of the association elsewhere even 
for naval hospital ships. In the navy the function of such ships 
is quite different than in the army. With the latter they con- 
stitute hospital transports, perhaps occasionally being used as 
floating hospitals, while with the former they constantly accom- 
pany the fleet, receiving sick and wounded from the war vessels, 
and after or perhaps during a battle collect all wounded who re- 
quire attention. ‘The executive and administrative problems in- 
volved in the management of naval hospital ships, therefore re- 
quire that officers of the medical department of the navy shall 
command them, moreover it is generally conceded that it is much 
more advantageous to entrust all positions on such ships to ofh- 
cers and men specially trained in aid to wounded sailors at sea. 
At hospitals, rest stations, etc., the work of the Red Cross with 
the navy will correspond exactly to that with the army, and the 
former should certainly receive its proper share of the popular 
contributions. Naturally naval demands on the Red Cross in 
any serious war in which both army and navy are engaged will 
not be so great as for the land forces. The sea forces would not 
be likely to number nearly as many officers and men and the con- 
ditions of naval warfare are such that the number of patients is 
not likely to be so great as:in the army. 


This is hardly the proper place to formulate regulations to 
govern the Red Cross in its relations with the army and thenavy. 
Such regulations are urgently needed, however, to set the stand- 
ard for Red Cross work and it is believed that a great deal of 
confusion will be avoided in the event of war by carefully thresh- 
ing out this subject in the cool blood of peace times. As soon as 


30 MAJOR CHARLES LYNCH. 


the proper rules are determined upon it is suggested that they be 
published as parts of the medical manuals of the army and of the 
navy and also by the Red Cross so that the personnel of both the 
governmental services and the association may become thoroughly 
familiar with them. 


It has, of course, been noticed that many of the suggestions 
made in this article presuppose preparations in peace for war. 
As has been stated this is the practice in all nations which have 
given the subject of voluntary aid their earnest attention. The 
organization of our Red Cross on the proper lines is a manifesta- 
tion of our realization of the desirability of similar action on our 
part. Methods which are universally regarded as the proper 
ones may generally be accepted as such without question and we 
must admit that unless a working plan for the operation of our 
Red Cross in war is made in time of peace and the material and 
machinery necessary to carry it through are obtained or created, 
our handicap will be a heavy one on the outbreak of war. Not- 
withstanding this fact the possibility of our going into a war this 
year or next year or at all events so soon that conditions in 
the Red Cross and in the army and the navy will be much as 
they are to-day must be squarely faced. It will then become 
our sole duty to do the best we can with what we have. The 
establishment of a community of interest between the govern- 
mental departments and the American National Red Cross has 
been a long step in the proper direction as the chiefs of the med- 
ical bureaus of the army and the navy are now in a position to 
indicate their needs with some assurance that the association will 
endeavor to meet them whatever they may be, nor is it antici- 
pated that funds will be lacking the Red Cross as our people al- 
ways generous in an emergency, will make it their business to 
supply them. The problem in the navy will not probably be 
such a difficult one but the army medical department must al- 
ways, under our present organization, be dangerously short on 
transportation, the necessity of an ample supply of which every 
writer on the subject has stated as the most important lesson 
taught by the medical service in the recent great war in the far 
East. ‘T‘his shortage will not be due to any innate hostility of 


THE AMERICAN NATIONAL RED CROSSINWAR. 31 


the department charged with furnishing transportation for our 
army. J’ransport in our service is not maintained in peace on a 
scale to meet the needs of war; the medical department has prac- 
tically none assigned to it in peace. Its necessities in this direc- 
tion are enormous in war, and the demands of troops and other 
departments are also great. 

If history can be relied upon this will be likely to eventuate, 
especially at first, despite the present excellent paper organiza- 
tion of the medical department of the army, in this department 
being without sufficient regulation transport simply because there 
is none to furnish it. The Surgeon General of the army may 
therefore be placed in the position of seeing all his plans in danger 
of failing through lack of transport. Whether this implies 
proper organization on the part of the army is not under discus- 
sion here, the facts are merely stated as they are today. This 
lack of transportation may be relieved by the department charged 
by law and regulations with furnishing it, certainly it may be 
relied upon to do so if in the midst of other very pressing duties 
this is practicable. Naturally the Surgeon General of the army 
will first call upon the quartermaster’s department for the trans- 
port which he requires. Suppose, however, that there is delay 
in furnishing it, could not the Red Cross making this its most 
important duty at this time buy or hire enough transportation to 
relieve the stress till other arrangements could be made? It 
seems to me that it could do so. What a difference it would 
have made at Santiago for example if the Red Cross had pur- 
chased a ship, loaded it down with ambulances or wagons which 
could be used for ambulance purposes, with the necessary animals, 
forage, food, and supplies, so that the association would not have 
had to call on the army for anything, have gone to Cuba, util- 
ized the transport and supplies for the use of wounded, another 
part of the personnel cleaning and disinfecting the ship mean- 
while and then have filled the vessel with selected cases for 
transportation to the United States, leaving the wagons, ambu- 
lances, etc., for the use of the army in Cuba. 

The details for the organization of such a ship would be a 
matter for arrangement at the moment; if practicable it should 


32 MAJOR CHARLES LYNCH. 


have the greatest possible number of officers and men of the 
medical department of the army simply because they would be 
likely to prove more efficient for such work. At all events jeal- 
ousies should not be allowed to. enter into the question, the per- 
sonnel being selected from army and Red Cross indiscriminately 
according to fitness, and speed rather than perfection in details 


should govern in selection of the equipment. ‘This would be the 


poetry of Red Cross work if it has any poetry, —the accomplish- 
ment of the apparently impossible,—and while the desire for such 
poetry should not be allowed to supersede the prose of steady, 
persistent efforts in peace to create an efficient Red Cross person- 
nel, and to collect the supplies which will be needed in time of 
war, both prose and poetry may have their place. 


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33193 Hy | 


